Objective: To assess the burden posed by foodborne diseases in Japan using methods developed by the World Health Organization's Foodborne Disease Burden Epidemiology Reference Group (FERG).

Methods: Expert consultation and statistics on food poisoning during 2011 were used to identify three common causes of foodborne disease in Japan: Campylobacter and Salmonella species and enterohaemorrhagic Escherichia coli (EHEC). We conducted systematic reviews of English and Japanese literature on the complications caused by these pathogens, by searching Embase, the Japan medical society abstract database and Medline. We estimated the annual incidence of acute gastroenteritis from reported surveillance data, based on estimated probabilities that an affected person would visit a physician and have gastroenteritis confirmed. We then calculated disability-adjusted life-years (DALYs) lost in 2011, using the incidence estimates along with disability weights derived from published studies.

Findings: In 2011, foodborne disease caused by Campylobacter species, Salmonella species and EHEC led to an estimated loss of 6099, 3145 and 463 DALYs in Japan, respectively. These estimated burdens are based on the pyramid reconstruction method; are largely due to morbidity rather than mortality; and are much higher than those indicated by routine surveillance data.

Conclusion: Routine surveillance data may indicate foodborne disease burdens that are much lower than the true values. Most of the burden posed by foodborne disease in Japan comes from secondary complications. The tools developed by FERG appear useful in estimating disease burdens and setting priorities in the field of food safety.

Figure 1: Flowchart for the selection of studies included in the systematic review on the disability associated with foodborne disease

Mentions:
We used systematic reviews of prospective cohort studies to estimate the proportions of these complications that could be attributed to gastroenteritis caused by each infectious agent. We searched the Japan medical abstract society database and Embase for relevant articles published between 1 January 1983 and 29 February 2012 and Medline for relevant articles published between 1 January 1946 and 29 February 2012.19 The search terms were designed by an information specialist using the appropriate medical subheadings (available from the corresponding author). We included prospective cohort studies that described, in English or Japanese, the proportions of laboratory-confirmed sequelae that resulted from gastroenteritis caused by Campylobacter, Salmonella or EHEC. We only used published data and made no attempt to obtain any further data from the authors of relevant articles. We excluded case reports, review papers, letters, comments, conference proceedings, studies with insufficient information on criteria, studies that only provided aggregated data for multiple conditions and unpublished studies (Fig. 1).

Figure 1: Flowchart for the selection of studies included in the systematic review on the disability associated with foodborne disease

Mentions:
We used systematic reviews of prospective cohort studies to estimate the proportions of these complications that could be attributed to gastroenteritis caused by each infectious agent. We searched the Japan medical abstract society database and Embase for relevant articles published between 1 January 1983 and 29 February 2012 and Medline for relevant articles published between 1 January 1946 and 29 February 2012.19 The search terms were designed by an information specialist using the appropriate medical subheadings (available from the corresponding author). We included prospective cohort studies that described, in English or Japanese, the proportions of laboratory-confirmed sequelae that resulted from gastroenteritis caused by Campylobacter, Salmonella or EHEC. We only used published data and made no attempt to obtain any further data from the authors of relevant articles. We excluded case reports, review papers, letters, comments, conference proceedings, studies with insufficient information on criteria, studies that only provided aggregated data for multiple conditions and unpublished studies (Fig. 1).

Objective: To assess the burden posed by foodborne diseases in Japan using methods developed by the World Health Organization's Foodborne Disease Burden Epidemiology Reference Group (FERG).

Methods: Expert consultation and statistics on food poisoning during 2011 were used to identify three common causes of foodborne disease in Japan: Campylobacter and Salmonella species and enterohaemorrhagic Escherichia coli (EHEC). We conducted systematic reviews of English and Japanese literature on the complications caused by these pathogens, by searching Embase, the Japan medical society abstract database and Medline. We estimated the annual incidence of acute gastroenteritis from reported surveillance data, based on estimated probabilities that an affected person would visit a physician and have gastroenteritis confirmed. We then calculated disability-adjusted life-years (DALYs) lost in 2011, using the incidence estimates along with disability weights derived from published studies.

Findings: In 2011, foodborne disease caused by Campylobacter species, Salmonella species and EHEC led to an estimated loss of 6099, 3145 and 463 DALYs in Japan, respectively. These estimated burdens are based on the pyramid reconstruction method; are largely due to morbidity rather than mortality; and are much higher than those indicated by routine surveillance data.

Conclusion: Routine surveillance data may indicate foodborne disease burdens that are much lower than the true values. Most of the burden posed by foodborne disease in Japan comes from secondary complications. The tools developed by FERG appear useful in estimating disease burdens and setting priorities in the field of food safety.